Objectives:Medical home models, like the VA Patient Aligned Care Team (PACT), seek to engage patients via proactive outreach, but little is known about patients' attitudes towards outreach scope, frequency, and mode of communication. Our objective was to better understand patients' preferences for receiving remote care.

Methods:We conducted a qualitative study of veterans with hypertension or current smoking histories. Participants were invited by mail to participate in focus groups which were stratified by site, gender (6 male and 4 female groups), and age (under or over age 60). A total of 1179 veterans were invited, 127 were scheduled to attend, and 77 participated. Discussion questions focused on facilitators and barriers to healthy behavior change, experience with current outreach efforts, and preferences for receiving additional care in-between outpatient visits. Each focus group was audio-recorded and transcribed; supplemental field notes were taken. A subset of transcripts was reviewed independently by four researchers, who then created an initial consensus codebook. Two researchers independently coded each transcript, modified the codebook as new themes emerged, and reconciled coding. NVivo qualitative software was used for further analysis.

Results:Participants generally appreciated existing outreach efforts, including post-discharge follow-up calls and reminder letters. Participants were receptive to additional outreach for referrals, appointment reminders, and motivational support between visits. However, they reported that these efforts should be tailored to individual needs and preferences in terms of frequency, scope, and mode of communication. Most participants were open to non-clinicians contacting them as long as they had proficient interpersonal skills, connection to their PACT, and relevant training. Some participants expressed a preference for direct communication with a medical professional. Moderate concerns over privacy were raised. While most did not explicitly state that the contact person needs to be a veteran, some felt that a veteran would be uniquely suited to the role and many stated that some understanding of military experience would be helpful.

Implications:Our findings indicate that veterans are receptive to proactive outreach for management of chronic conditions, especially when this outreach is personalized and flexible.

Impacts:The information gathered from this study will inform the design of future outreach efforts.